Enrolling Vietnamese and Chinese Women in Breast Cancer Treatment and Prevention Trials

Background and Significance

With respect to some Asian-American women, studies have addressed some of the problems inherent in undertaking primary and secondary prevention strategies for cancer. Tertiary prevention for cancer is synonymous with treatment. Cancer therapies are aimed at reducing the complications and mortality associated with known cancer, as well as preventing recurrence or relapse. For early stage breast cancer, breast conserving surgery and radiation therapy have been shown to be effective. With regard to tertiary prevention, very few cancer clinical trials have involved adequate numbers of Asian women. Thus, understanding why Asian women are not enrolled in these types of trials would be the first step toward designing trials and treatments to benefit this population.

Cancer is the leading cause of death in Asian American women, and breast cancer was the most commonly diagnosed cancer among Asian American women. Findings from major cancer prevention or treatment trials often cannot be generalized to ethnic minorities due to their lower rates of trial participation. Issues in research participation among Asian patients and providers has not been studied extensively. This study will include perspectives from primary care providers, oncologists and patients with and without cancer, providing a broad-based examination of the attitudes and beliefs, enhanced by qualitative and quantitative data.

Study Aims

Given that there is a lack of knowledge regarding why there are few Vietnamese or Chinese women who enroll in cancer clinical trials, the general aim of this project is to explore, in qualitative and quantitative terms, some of the potential barriers to enrolling these women.

The specific questions are:

1. What are the barriers that confront physicians who care for Vietnamese and/or Chinese women with respect to enrolling them in breast cancer primary prevention trials or treatment trials? Do these barriers differ with respect to the ethnicity of the physician, the demographics of the physician's patient base (e.g. those who take care of many Vietnamese and/or Chinese women compared to those who take care of a few), or the setting of their practice (e.g. those who work in private practice compared to those who work in a managed care setting or those who work in a public setting).
2. What are the barriers that confront Vietnamese and Chinese women with respect to enrolling in breast cancer clinical trials? What are their attitudes toward research in general and breast cancer prevention/treatment in particular? What are their perceived risks of breast cancer, and how do their perception of risk affect their attitudes? What are the access issues for women who contemplate participation?
3. What are potential solutions to these barriers from the physicians' and the patients' perspectives?

Methods

This research project was aimed at two groups - physicians, and potential cancer clinical trial subjects. Vietnamese women were the first ethnicity studied, followed by Chinese women. Physicians were surveyed for their attitudes and their perception of barriers toward enrolling these women into breast cancer chemoprevention or treatment trials. Focus groups were used to evaluate attitudes of Asian women toward cancer clinical trials. Additionally, since cancer patients views may differ, semi-structured interviews were conducted among women who have had breast cancer to elicit their attitudes toward and perceptions of cancer treatment trials.

Project Status

This project was funded as an administrative supplement to the CRN. The project leader is Tung Nguyen from the University of California at San Francisco. Analyses are nearing completion.

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